Individual
SHANNON M FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1055 N MAYFAIR RD, WAUWATOSA, WI 53226
(414) 479-2300
Mailing address
1055 N MAYFAIR RD, WAUWATOSA, WI 53226-3436
(414) 479-2300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1545-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43917700
—
WI
01
—
500014946
MEDICARE RAILROAD
WI
Enumeration date
06/20/2006
Last updated
11/18/2021
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